Job description of a nurse inhaler. Nurse job description. Senior nurse
A nurse is a specialist with a secondary medical education. This level of special knowledge is given in a medical college.
Nurses have three main tasks: to help the doctor, to carry out his appointments and to care for the patient (nursing process). Nurses are considered nursing staff. The list of their duties depends on the profile of the medical institution, the department where the nurse works and the position held.
Nurses are different
A nurse can take one of many positions and thus grow professionally.
The top rung in the "hierarchy" of nurses is the head nurse.
In order to take this position, you need to have a higher education - successfully complete the faculty of higher nursing education. The duties of the chief nurse include the rational organization of the work of personnel, the organization of retraining of workers, and control over their activities.
The head nurse is the assistant to the head of the department for all administrative and economic issues. The elder sister is the immediate supervisor of the ward nurses and junior staff.
The duties of ward nurses include fulfilling medical appointments, monitoring and caring for patients, in particular, organizing their meals.
The procedural sister also fulfills the doctor's prescriptions, helps him with various manipulations.
Operating room nurses help surgeons by preparing instruments, underwear, suture and dressing material.
The district nurse assists the district doctor during the reception of patients, according to his appointment, performs procedures at the patient's home, participates in the implementation of measures to prevent diseases.
A separate "kind" of nurses are specialists assisting a neurologist, an ophthalmologist and other "narrow" doctors.
A dietitian, or dietitian, is a dietitian's assistant. She organizes medical nutrition and controls its quality. Her responsibilities include monitoring the processes of processing and distributing dishes, the sanitary condition of the kitchen and dining room.
List of duties common to all nurses
Despite such a wide variety of positions and functional responsibilities, there is a certain list of functions that is common to all nurses.
This list includes:
- direct implementation of the appointments of the attending doctor (mustard plasters, injections, enema, distribution of medicines);
- implementation of the nursing process - the initial examination of the patient, the removal of vital signs, the collection of biological material for further analysis, patient care, including the organization of their nutrition;
- assistance before the arrival of a doctor;
- transportation of patients;
- reception and discharge of patients;
- control of the sanitary condition of the hospital departments;
- control of observance by patients of the order of medical institution;
- document management.
Functional duties of a nurse in a polyclinic
Execution conditions: outpatient clinics
1. Fulfillment of medical and diagnostic appointments in the clinic and at home
2. Carrying out preventive and sanitary-educational measures
3. Preparation of an outpatient appointment with a local general practitioner (preparation of the workplace, instruments, tools, individual cards of an outpatient, forms, prescriptions, etc., timely receipt of results and posting them on cards, etc.).
4. Measurement of blood pressure in patients at the direction of the local general practitioner, thermometry and other medical manipulations.
5. Under the supervision of a doctor, filling out statistical coupons, emergency notification cards, referral forms for medical and diagnostic procedures, entering fluorographic and other data into outpatient cards of patients, helps to fill out dispatch sheets for VTEK, sanatorium-resort cards, extracts from outpatient cards .
6. Issuance of coupons to patients for repeated visits to the doctor.
7. Instructing patients on preparation for laboratory and instrumental studies.
8. Under the supervision of a doctor, filling out a dispensary observation card for newly diagnosed patients.
9. Preparation of preliminary materials for the preparation of a report on the medical examination of the population of the site.
10. Complete with the necessary tools and medicines for the therapist's bag for home care.
11. Performing manipulations and taking material for bacteriological studies in accordance with the doctor's prescription.
12. Informing the attending physician about the performance of diagnostic and therapeutic procedures and all cases of regimen violation by patients left for home treatment.
13. Carrying out preventive vaccinations under the guidance of a doctor and their registration.
MEDICAL SERVICE No. 3
Effective Communication Technique
Functional purpose: diagnostic, therapeutic, prophylactic
Conditions of implementation: outpatient, inpatient, emergency care at home, sanatorium-resort
Objective: to learn effective communication
1. Choose a time for communication that is convenient for the patient, not busy with procedures
2. Speak slowly, with good pronunciation, giving the patient time to absorb the information.
3. Do not abuse terminology without causing fear in the patient of unknown and incomprehensible information
4. Choose the pace and speed of speech for a particular person, taking into account the characteristics of perception and information processing in different patients
5. Do not start a conversation with unfavorable information in order to prevent negative emotions that make communication difficult
7. Ask open-ended questions in order to get more accurate answers.
8. Carefully use a sense of humor, taking into account the different perception of information and the degree of sense of humor in patients
Technique for Effective Written Communication
Objective: to learn effective written communication
Equipment: pens with rods of different colors, paper, dictionary.
1. Write neatly for better perception and understanding of written information
2. Choose the correct size and color of letters, as patients may have different levels of visual acuity, color perception
3. Include in the note all the necessary information to eliminate ambiguities, doubts and questions from the patient
4. Write competently, as mistakes distort information and undermine the authority of the nurse
5. Use clear and simple words (difficult words and incomprehensible terms make it difficult to understand and cause anxiety and fear in patients)
6. Sign the message in order to provide the patient with the opportunity, if necessary, to obtain additional information
MEDICAL SERVICE No. 4
Individual patient education plan for blood pressure self-monitoring
Objective: to teach the patient and family members to self-manage blood pressure
Type of training: individual
Conditions of implementation: outpatient, inpatient, emergency care at home.
Equipment: (tonometer, phonendoscope, pen, temperature sheet, ruler), observation diary.
I. Preparation for the procedure:
1. Warn the patient about the upcoming training, determine the motivation and ability to learn.
2. Clarify the patient's understanding of the purpose and course of the learning process and obtain his consent to conduct.
3. Prepare the equipment and select the correct cuff size.
II. Execution of the procedure:
4. Familiarize the patient with the device of the tonometer and phonendoscope
5. Warn that the measurement is carried out no earlier than 15 minutes after exercise
6. Demonstrate the cuff application technique:
7. Put the cuff on your left bare shoulder 2-3 cm above the elbow (clothes should not squeeze the shoulder above the cuff); fasten the cuff so that only one finger passes through. The center of the cuff is over the brachial artery (it is desirable that the patient sit quietly with the cuff applied for 5 minutes).
8. Demonstrate the technique of connecting the cuff and pressure gauge
9. Check the position of the pressure gauge needle relative to the zero mark of the scale.
10. Demonstrate the technique of palpation of the pulse on the brachial artery in the area of the elbow
11. Insert the olives of the phonendoscope into the ears and put the membrane of the phonendoscope in place of the pulsation so that the membrane is under the cuff
12. Demonstrate the technique of using the "pear":
Take a manometer in the hand on which the cuff is applied, in the other - a “pear” so that the 1st and 2nd fingers can open and close the valve.
Close the valve on the "pear", turning it to the right, with the same hand quickly inflate the cuff with air after the disappearance of Korotkov's tones (or pulsation of the radial artery) by another 30 mm Hg. Art. above.
Release air from the cuff at a speed of 2-3 mm Hg. Art. in 1 s by turning the valve to the left.
At the same time, listen to the tones on the brachial artery with a phonendoscope and monitor the readings on the pressure gauge scale: when the first sounds (Korotkov sounds) appear, “mark” on the scale and remember the number corresponding to the systolic pressure.
Focus the patient's attention on the fact that the appearance of the first sounds corresponds to the value of systolic pressure, and the transition of loud sounds to muffled or their disappearance corresponds to the value of diastolic pressure.
Repeat the procedure after 2-3 minutes.
13. Round off the measurement data to 0 or 5, write it down as a fraction: in the numerator - systolic pressure; in the denominator - diastolic (research data taken by the smallest dimension).
14. Ensure that the patient has learned the technique of measuring blood pressure by asking them to demonstrate the procedure. Provide written instructions if necessary.
15. Teach keeping an observation diary.
III. End of procedure:
16. After use, wipe the membrane and olives of the phonendoscope with a gauze ball with alcohol.
17. Wash your hands.
Nursing plan
FULL NAME. patient ______ Petrov Ivan Nikolaevich ______________________________
Department _______ Therapeutic __________________________________
Room No. _________ No. 4_______________________________________________
The essence of planning is to determine (together with the patient):
Objectives (expected result) for each problem
The nature and extent of nursing intervention required to achieve the goals
Duration of nursing intervention
In order to evaluate the outcome of nursing care, the goals must be stated in measurable terms, i.e. recorded as a change in the patient's behavior, his verbal reaction, specific changes in the dynamics of the state, the measurement of certain physiological indicators.
Nursing interventions are recorded in the care plan - a list of nurse actions aimed at solving the problems of a particular patient. It is important to use specific terms and detailed description of activities to describe interventions.
All nursing interventions fourth stage nursing process - implementations, after completion, are recorded in the protocol for the care plan indicating the time, the action itself and the patient's response to nursing intervention.
protocol for care plan
Department _____ therapeutic No. 1 __________________________________
Chamber___# ____________________________________________________________
Name of the patient _____ Petrov Ivan Nikolaevich ___________________________
Medical diagnosis ___ Duodenal ulcer __________________
Final grade _________ positive _____________________________
Sister's signature ____ Kotova E.V. _____________________________________
Current assessment of the effectiveness and quality of nursing care (fifth stage of the nursing process) produced by the sister all the time. The purpose of the final evaluation is to determine the result, i.e. the state of the patient achieved as a result of nursing intervention. The nurse will need the same skills to perform the final assessment as in the initial assessment of the patient's condition.
If the goal is achieved, a clear entry in the care plan is "Goal Achieved". If not achieved or not fully achieved, the patient's verbal or behavioral response should be recorded.
Remember!
Document all nursing interventions as soon as possible
Record vital interventions immediately
Always record deviations from the norm of the patient's condition
Sign clearly in each column indicated for the signature
Document facts, not opinions
Do not use "vague" terms
be precise, describe briefly
Focus on 1-2 issues or important events of the day daily
Record patient non-compliance with doctor's orders or refusals
Do not leave free columns in the documentation
Record only interventions performed by the nurse
Additional information about the features of the implementation of the technique
The nurse must constantly monitor the appearance and condition of the patient, and inform the doctor of any changes in the condition. Observation of the appearance and condition of the patient is determined by: the state of consciousness, the position of the patient, the general appearance, the condition of the external integument.
There are 5 types of states of consciousness:
1. A state of clear consciousness, when the patient specifically and quickly answers questions.
2. A state of clouded consciousness, in which the patient answers correctly, but with a delay.
3. Stupor - the patient is in a state of stupor, does not answer questions or answers meaninglessly.
4. Sopor - pathological sleep, the patient is unconscious, but his reflexes are preserved.
5. Coma - complete suppression of consciousness with the absence of reflexes.
A short-term loss of consciousness due to anemia of the brain is called fainting.
There are three positions of the patient: active, passive and forced.
The general appearance of the patient and especially the physique in some cases make it possible to judge the state of his health. According to the posture of the patient; his manner of bearing, one can draw a conclusion about the severity of the disease, the development of muscles, and sometimes about professional habits.
Most seriously ill or mentally depressed people are hunched over. During an external examination, the type of constitution is determined (anatomical and physiological features of the body inherited from parents and in interaction with the external environment). There are three constitutional types: normosthenic, asthenic, hypersthenic.
Examination of the face is of great help in the diagnosis of various diseases. When examining peritonitis (inflammation of the peritoneum), facial features are sharpened, eyes sink, profuse sweat appears (Hippocrates' face). With kidney disease, the face is edematous, pale.
In febrile patients, the face takes on an expression of excitement: the cheeks are red, the eyes are shining.
NOSE. Constant reddening of the nose with developed small vessels is observed in chronic alcoholism. Epistaxis can be caused by local causes and general diseases (hypertension, blood disease).
When examining the EYE, pay attention to the condition of the cornea, conjunctiva, pupils. Protrusion of the eyes (exophthalmos), trembling of the eyelids are signs of thyroid disease. Staining of the sclera and conjunctiva in yellow is an early symptom of jaundice. Constriction of the pupils is observed in case of poisoning with morphine, opium, brain tumors, and dilation - in case of poisoning with atropine, in coma.
Pay attention to the color of the skin and mucous membranes. PALE skin develops primarily as a result of a decrease in the amount of blood in the vessels of the skin (cooling, blood loss, malignant tumors). In addition, pallor occurs in patients with edema in kidney disease due to squeezing of skin vessels.
REDENTION (HYPEREMIA OF THE SKIN) can have different shades, reach a purple-cherry color, due to an increase in the content of erythrocytes and hemoglobin in the blood. Redness of the skin is also caused by vasodilation of the skin (with fever), the use of vasodilators (nitroglycerin).
Jaundice occurs due to excessive accumulation of bile pigments (bilirubin) in the blood and their deposition in the skin. Jaundice is distinguished: mechanical, parenchymal and hemolytic. MECHANICAL occurs when there is a violation of the outflow of bile from the gallbladder and liver into the duodenum. Bile lingers in the bile ducts and liver and partially enters the bloodstream, and from it into the skin (cholelithiasis, cholecystitis).
WHEN THE PARENCHYMA OF HEPATIC CELLS IS DAMAGED (Botkin's disease, toxic hepatitis). Bile enters not only the bile ducts, but also into the blood vessels. Such jaundice is called parenchymal.
With hemolytic jaundice, there is an increased breakdown of red blood cells. Jaundice can be true or false. FALSE jaundice occurs when taking carotene, picric acid, tomato and carrot juice. Staining in yellow occurs only in the skin. In TRUE jaundice, the sclera of the eyes and mucous membranes are stained yellow in addition to the skin, the content of bilirubin in the blood rises, and bile pigments appear in the urine.
CYANOSIS (BLUE) distinguish between local and general.
GENERAL cyanosis occurs as a result of insufficient blood saturation with oxygen and excessive accumulation of carbon dioxide in it (lung disease when gas exchange is disturbed). LOCAL acrocyanosis in violation of blood flow in the tissues. In this case, cyanosis of the tip of the nose, ears, fingers and toes is noted.
RASHES are of a diverse nature erythema (large-spotted, skin lesions), urticaria (whitish blisters that rise above the skin surface), urticaria (whitish blisters that rise above the skin surface), roseola (reddening of the skin in the form of a limited inflammatory expansion of capillaries). They are of great importance for the recognition of infectious and allergic diseases.
Edema is local and general. LOCAL edema develops with a local inflammatory process or due to local obstruction of the outflow of blood (arthritis, furuncle, Quincke's edema). GENERAL edema is observed not only on the legs, arms, face, but also in the serous cavities. Such a massive widespread edema is called anasarca. The accumulation of edematous fluid in the pleural cavity is called hydrothorax, in the abdominal cavity - ascites, in the pericardium - hydropericardium. A slight swelling of the face, legs is called pastosity.
MANIPULATION #7
Pain Intensity Assessment
Functional purpose: diagnostic
Conditions of implementation: outpatient, inpatient, transportation in an ambulance
I. Preparation for the procedure
1. Make sure the patient is conscious.
1.1. When diagnosing consciousness other than clear, use the Glasgow Coma Scale to determine the level of depression of consciousness.
2. Convinced of the possibility of verbal contact with the patient, taking into account the severity of the condition, age, level of consciousness, speech impairment, the presence or absence of a language barrier.
2.1. If verbal contact with the patient is impossible, diagnose and document verbal signs of pain syndrome (pain markers).
II. Performing the procedure.
3. If there is a clear consciousness and the possibility of verbal contact, assess the degree of pain at the diagnostic level.
3.1. Ask the patient about pain.
3.2. When the patient confirms the presence of pain syndrome:
3.2.1. Invite the patient to rate the intensity of pain on a 5-point scale.
3.2.2. Find out the location of the pain.
3.2.3. Find out the irradiation of pain.
3.2.4. Find out the duration of the pain.
3.2.5. Find out the nature of the pain.
3.2.6. Document the results. Pain zones are described in terms of topographic anatomy or marked on a schematic representation of the human body.
3.3. If the patient denies the presence of pain syndrome, document in the medical records the fact of the absence of pain at the time of examination.
4. When conducting a re-examination of the level of pain (dynamic monitoring of the level of pain), assess the level of pain at the level of dynamic assessment
4.1. Invite the patient to note the current level of pain on a 10-point scale of visual analog control.
4.2. Ask the patient to note on the same scale the level of pain at the time of the previous examination.
4.3. Assess the positive/negative dynamics of the subjective assessment of the pain syndrome in absolute and/or relative terms.
4.4. Document the results.
5. When conducting a primary assessment of the level of pain, as well as when changing the nature of the pain syndrome, assess the level of pain at a descriptive level.
5.1. Instruct the patient on how to complete the McGill questionnaire to determine the severity of pain.
5.2. Provide the patient with a questionnaire form and a fountain pen.
5.3. Upon completion of the filling, calculate the rank indices for 4 main groups (sensory sensations, emotional sensations, intensity assessment, parameters reflecting the general characteristics of pain); based on the obtained indicators, calculate the rank index of pain (RIB).
5.4. Fill in the calculated fields of the questionnaire form.
5.5. Based on the data obtained in paragraph 3.2.1., fill in the field "real feeling of pain intensity" (NIB).
III. End of procedure
6. Familiarize the patient with the results.
7. Wash (using an antiseptic or soap) and dry your hands.
8. Make an appropriate record of the results of the implementation in the medical documentation.
9. If the patient refuses to conduct an assessment, as well as if there are suspicions about the truth of the data provided (simulation, aggravation, dissimulation), diagnose and document non-verbal signs of pain (pain markers).
Additional information about the features of the implementation of the technique.
When assessing the level of pain on the McGill scale, it is necessary to ask the patient to mark one word that most accurately reflects his pain sensation in any (not necessarily in all) classes of the rating scale.
In pediatric, geriatric, psychiatric practice, as well as in cases where the assessment of the level of pain is difficult due to the language barrier, it can be used pictographic scale, schematically depicting the facial expression of a person.
To non-verbal signs of pain ( pain markers) relate:
Wet skin
Tachycardia and tachypnea not associated with the disease
Tears, wet eyes
pupil dilation
forced posture
Characteristic facial expressions - clenched teeth, tension of the facial muscles of the face (frowning forehead, pursed lips)
Pressing the hand on the place of pain, stroking and rubbing it
Violation of eye contact (shifting eyes).
Changing speech (tempo, coherence, style)
Behavioral reactions (motor restlessness, finger tapping, restlessness)
Emotional reactions: capriciousness, irascibility, emotional lability, outbursts of aggression.
Sleep disturbance
Loss of appetite
Longing for loneliness
Moaning during sleep or when the patient thinks he is alone
Frequent and varied complaints not related to pain.
SCALE FOR EVALUATION OF PATIENT'S PAIN DESCRIPTION.
MEDICAL SERVICE No. 9
MEDICAL SERVICE No. 10
I. Preparation for the procedure
1. Unfold the package with gloves (you can put the package on the table)
II. Performing a procedure
2. Take the glove by the lapel with your left hand so that your fingers touch the inside of the glove.
3. Close the fingers of the right hand and insert them into the glove.
4. Open the fingers of your right hand and pull the glove over your fingers without disturbing its lapel.
5. Put under the lapel of the left glove 2,3 and the 4th fingers of the right hand, already wearing a glove, so that the 1st finger of the right hand is directed towards the 1st finger on the left hand.
6. Hold the left glove 2,3 and 4 with the finger of the right hand vertically.
7. Close the fingers of your left hand and insert it into the glove.
III. Completion of the procedure.
8. Straighten the lapel first on the left glove, pulling it over the sleeve, then on the right with the help of the 2nd and 3rd fingers, bringing them under the tucked edge of the glove.
Depending on the situation, it is better to wear gloves on the sleeves of the gown. In cases where a long-sleeved robe is not required, gloves cover the wrist and part of the forearm.
used gloves removed as follows:
1. With the finger of your right hand in a glove, make a lapel on the left glove, touching it only from the outside.
2. With the finger of your left hand, make a lapel on the right glove, also touching it only from the outside.
3. Remove the glove from the left hand by turning it inside out and holding the lapel.
4. Hold the glove removed from your left hand in your right hand.
5. With your left hand, take the glove on your right hand by the lapel from the inside and remove the glove from your right hand, turning it inside out.
6. Place both gloves (the left one is inside the right one) in a container with a disinfectant or throw it away in a waterproof bag.
MEDICAL SERVICE No. 11
Technology No. 13
Procedure algorithm
I. Room cleaning.
1. During cleaning, open the windows, ventilate the room. In winter, during cleaning, the sick should be well covered, tied with a scarf or towel, and tucked a blanket under their feet. Patients on semi-bed rest are asked to leave the room.
2. Cleaning of the wards and all other rooms is carried out in a wet way, because. dust contains a large number of microbes that cause various diseases. In the morning, wet cleaning is done after breakfast, so that by 9 o’clock the doctor’s round will be clean.
3. Re-wet cleaning is done before a quiet hour and before going to bed.
4. You need to start wet cleaning from bedside tables. They wipe the dust from them, remove unnecessary items, control the products in the bedside table (perishable ones should be stored in the refrigerator).
5. Then wipe the dust from the windowsill and other furniture.
6. During cleaning, the room should be quiet.
7. The floor must be washed from windows and walls to the door. Garbage is collected in the hallway.
8. The issue of ventilation is discussed with patients.
NOTE:
v For washing each ward, a working solution of disinfectant is prepared.
v In the Infectious Diseases Hospital, general cleaning of the wards is carried out once a week.
v The bucket and cloth marked as shown should only be used for its intended purpose.
v If there is a patient in the room who is allergic to the smell of chlorine, then the floor should be washed with a disinfectant of a different composition.
Procedure algorithm
1. Wear protective clothing
2. Inspect the premises for the purpose of cleaning
3. With a clean rag soaked in a chemical disinfectant used in a hospital, wipe the surfaces of window sills, furniture, equipment, appliances and then the floor
4. Wipe the floors using the "two buckets" method
Moisten the cleaning rags in the disinfectant solution of container No. 1 and thoroughly wipe the surface to be treated
Rinse the rags in container No. 2, wring out,
Re-moisten in disinfectant solution and wash untreated floor surfaces
Change the disinfectant solution taking into account the consumption rate, and water as it gets dirty
Cleaning equipment after disinfection should be disinfected, rinsed, dried and stored in a special cabinet or designated place.
5. Turn on germicidal lamps.
6. Ventilate the premises
OFFICE CLEANING BY THE TYPE OF FINAL DISINFECTION.
GOAL: minimizing the number of disease-causing particles after the complete cleaning of surgical rooms, reducing the risk of cross-contamination.
INDICATIONS: premises of the operating block, surgical, dressing, procedural and other manipulation rooms.
EQUIPMENT:
Disinfectant (washing) solutions permitted for use in the Russian Federation in accordance with the established legal procedure;
Sterile rags
Cleaning equipment, or stationary or portable wet-vacuum cleaning system;
Protective clothing for medical staff: clean gown, moisture-resistant apron, headgear, respirator mask, goggles, thick rubber gloves, flat-heeled washing shoes.
Regularity - 1 time in 7 days, according to the schedule of general cleaning, approved by the head of the department.
Procedure algorithm
1. Wear protective clothing.
2. Inspect the premises for the purpose of cleaning.
3. Carry out preliminary cleaning of the premises with the use of detergent solutions.
4. Wipe the floors using the "two buckets" method.
5. Disinfect: with a clean rag, abundantly moistened with a disinfectant chemical detergent, wipe the surfaces of window sills, furniture, equipment, appliances and then the floor (irrigation from spray equipment is possible).
6. Exposure of the disinfectant extract.
7. Wipe surfaces with a sterile cloth.
8. Turn on germicidal irradiators with ultraviolet light (direct or reflected)
9. Ventilate the room.
Cleaning equipment after disinfection should be disinfected, rinsed, dried with rags and stored in a special cabinet or designated place.
MEDICAL SERVICE No. 14
MEDICAL SERVICE No. 15
Technology Algorithm
1. Prepare a working solution of azopyram by mixing equal volumes (1/1) of the stock solution of azopyram and 3% hydrogen peroxide, the working solution is only usable for 1-2 hours.
2. Check the activity of the working control by dropping a few drops on the slide with a blood smear.
3. Wipe cold products (not higher than 25 0) with a swab moistened with a reagent or apply 3-4 drops of a working solution with a pipette into a syringe and move the reagent several times with a piston. At higher temperatures, the reagent is destroyed
4. Exposure 0.5-1 minute. Control of suitability and activity of the working control.
5. Displace the solution from the syringe onto a gauze napkin or wipe a smooth product with a gauze napkin. Ensure the penetration of the working solution into the joints.
6. Sample reading:
Brownish staining appears in the presence of oxidizing agents, chlorine-containing substances, washing powder, bleaches, rust. If the color change occurs later than one minute, the sample is not counted.
7. Evaluation of the result.
8. Regardless of the test result, rinse the product with water or alcohol to remove toxic substances.
9. With a positive sample, the entire batch of products is subject to re-cleaning.
10. Record the result of the test in the log book.
11. Clean up until a negative test result appears.
B. PHENOLPHTHALEIN TEST.
GOAL: quality control of pre-sterilization cleaning of instruments for the completeness of washing instruments from detergents. In the centralized pre-sterilization room (CSO) - daily
Self-monitoring in the department - once a week
The Center for Sanitary and Epidemiological Surveillance controls health care facilities once a quarter.
EQUIPMENT: 1% of products of the same name, but not less than 3-5 pieces; 1% alcohol solution of phenolphthalein; gauze napkins; cotton swabs; pipettes or syringe, a pre-sterilization cleaning control log, alcohol, soap, a dispenser with a disposable towel.
Technology Algorithm
1. Prepare a 1% alcohol solution of phenolphthalein.
2. Wipe (introduce inside) the instrument, syringe, needle or cotton swab with an alcohol solution of 1% phenolphthalein and move the reagent several times with a piston.
3. Exposure - 0.5-1 minute. If the color change is later than one minute, the sample is not counted.
4. Displace the solution from the syringe onto a gauze napkin or a smooth product, wipe it with a gauze napkin.
5. Sample Reading:
- "Pink" staining - in the presence of detergents (positive test);
No staining - (negative test) in the absence of detergents.
6. Regardless of the results of the sample, the products are washed with water or alcohol.
7. With a positive sample, the entire batch of products is subject to repeated washing under running water.
8. Record the result of the test in a journal.
9. Clean up until a negative test result appears
B. SUDAN TEST III.
EQUIPMENT: 1% of products of the same name, but not less than 3-5 pieces; Sudan III, ammonia, distilled water, gauze wipes; cotton swabs; pipettes or syringe, a pre-sterilization cleaning control log, alcohol, soap, a dispenser with a disposable towel.
1. Prepare 0.2 grams of sudan III. ammonia, distilled water, mixing equal volumes (1/1) of the initial solution, the working solution is suitable for use only for 14 days.
2. Wipe cold products (not higher than 25 0) with a swab moistened with a reagent or apply 3-4 drops of a working solution with a pipette into a syringe and move the reagent several times with a piston. At higher temperatures, the reagent is destroyed
3. Exposure 0.5-1 minute. Control of suitability and activity of the working control.
4. Displace the solution from the syringe onto a gauze napkin or wipe a smooth product with a gauze napkin. Ensure the penetration of the working solution into the joints.
5. Sample Reading:
Pink-lilac staining appears when hemoglobin is present on the product;
Brownish coloring appears in the presence of oxidizing agents, chlorine-containing substances, washing powder, bleaches, rust. If the color change is later than one minute, the sample is not counted.
6. Evaluation of the result.
7. Regardless of the test result, rinse the product with water or alcohol to remove toxic substances.
8. With a positive sample, the entire batch of products is subject to re-cleaning.
9. Record the result of the test in the log book.
10. Clean up until a negative test result appears.
MEDICAL SERVICE No. 16
The technique of using sterile bix in the treatment room
Functional purpose - preventive
Conditions of implementation - outpatient, inpatient, sanatorium-resort.
PURPOSE: maintaining the sterility of the dressing material, ensuring asepsis
INDICATIONS:
invasive procedures
treatment of skin and mucous membranes
EQUIPMENT: soap or antiseptic solution for hand treatment, sterile gloves, manipulation table, bix on a stand with sterile material, sterile gripping tools (tweezers, forceps) in a craft bag, 70% alcohol, sterile tray, tray (small) non-sterile.
Procedure algorithm
1. Put on a gown, cap, mask.
2. Pay attention to the tightness of the bix, and the date of sterilization on the tag of the bix.
3. Open the latch on the bix.
4. Wash your hands in a hygienic way.
5. Put on sterile gloves.
6. Remove the sterile tweezers from the kraft bag and place on the sterile tray.
7. Open the bix cover by pressing the stand pedal.
8. Remove the sterilization indicator with sterile tweezers and check compliance with the sterilization regimen.
9. Discard the sterilization indicator into a non-sterile tray and keep until the end of the work shift.
10. With sterile tweezers, “open” the corners of the sterile diaper in the bix and get the right amount of sterile dressing
11. One of the corners of the sterile diaper cover the dressing material in the bix, leave the rest outside.
12. Close the bix cover by releasing the pedal.
13. Put the sterile forceps into the sterile tray.
14. The shelf life of sterile material in a hidden bix is 2 hours.
MEDICAL SERVICE No. 17
Sister's hand position.
The selected method of holding during transfer depends on the presence of painful areas in the patient and what kind of assistance will be provided to him during transfer.
It is necessary to control the position of the body and movements of the patient as much as possible.
The position of the patient. Before lifting (moving), you need to help him lie down or put him in a comfortable position, taking into account the biomechanics of the body during the subsequent movement.
The position of the back and spine of the sister during movement must be straight. Shoulders, as far as possible, should be in the same plane with the pelvis. When lifting the patient with one hand, the other, free, maintains the balance of the body and, consequently, the position of the back, being a support for relieving the load from the spine.
Some patients may be helped to lift themselves by doing a few rocking movements with the help of a sister to create propulsion. In this case, the actual force expended by the nurse to lift the patient in the standing position may be minimal.
When dealing with even a helpless patient, gentle rocking of him and his sister can kick-start the movement and facilitate the lifting process. These skills can be learned, but this requires a sense of rhythm, coordination of movements, as well as understanding and cooperation on the part of the patient.
Team work. Patient movement can only be successful if movements are coordinated.
1. This job description defines the job duties, rights and responsibilities of a nurse.
2. A person who has a secondary vocational education in the specialty "General Medicine", "Obstetrics", "Nursing" and a certificate of a specialist in the specialty "Nursing", "General Practice", "Nursing in Pediatrics" is appointed to the position of a nurse no requirement for work experience.
The senior nurse must have a secondary vocational education (advanced level) in the specialty "General Medicine", "Obstetrics", "Nursing" and a certificate of a specialist in the specialty "Nursing", "General Practice", "Nursing in Pediatrics" without requirements for work experience.
3. A nurse should know: laws and other regulatory legal acts of the Russian Federation in force in the field of healthcare; theoretical foundations of nursing; the basics of the treatment and diagnostic process, disease prevention, promotion of a healthy lifestyle; rules for the operation of medical instruments and equipment; statistical indicators characterizing the state of health of the population and the activities of medical organizations; rules for the collection, storage and disposal of waste from medical organizations; fundamentals of functioning of budget-insurance medicine and voluntary medical insurance; fundamentals of valeology and sanology; basics of dietology; the basics of clinical examination, the social significance of diseases; basics of disaster medicine; rules for maintaining accounting and reporting documentation of a structural unit, the main types of medical documentation; medical ethics; psychology of professional communication; fundamentals of labor legislation; internal labor regulations; rules on labor protection and fire safety.
4. A nurse is appointed and dismissed by order of the head of a medical organization in accordance with the current legislation of the Russian Federation.
5. The nurse reports directly to the head of her structural unit (department), and in his absence to the head of the medical organization or his deputy.
2. Job responsibilities
Provides pre-hospital medical care, collects biological materials for laboratory research. Provides care to patients in a medical organization and at home. Performs sterilization of medical instruments, dressings and patient care items. Assists in the doctor's treatment and diagnostic manipulations and minor operations in outpatient and inpatient settings. Conducts preparation of patients for various kinds of research, procedures, operations, for outpatient doctor's appointments. Ensures fulfillment of medical orders. Carries out accounting, storage, use of medicines and ethyl alcohol. Maintains personal records, information (computer) database of the health status of the population served. Supervises the activities of junior medical staff. Maintains medical records. Carries out sanitary-educational work among patients and their relatives on health promotion and disease prevention, promotion of a healthy lifestyle. Collects and disposes of medical waste. Carries out measures to comply with the sanitary and hygienic regime, the rules of asepsis and antisepsis, the conditions for sterilizing instruments and materials, the prevention of post-injection complications, hepatitis, HIV infection.
3. Rights
The nurse has the right to:
1. make proposals to the management to improve the organization and improve the conditions of their work;
2. to control, within its competence, the work of junior medical personnel (if any), give them orders and demand their precise execution, make proposals to the management for their encouragement or imposition of penalties;
3. request, receive and use information materials and legal documents necessary for the performance of their duties;
4. to take part in scientific and practical conferences and meetings, which discuss issues related to his work;
5. pass certification in accordance with the established procedure with the right to obtain the appropriate qualification category;
6. to improve their qualifications at refresher courses at least once every 5 years.
A nurse enjoys all labor rights in accordance with the Labor Code of the Russian Federation.
4. Responsibility
The nurse is responsible for:
1. implementation of the official duties assigned to it;
2. timely and qualified execution of orders, instructions and instructions of the management, regulatory legal acts in their activities;
3. compliance with internal regulations, fire safety and safety;
4. timely and high-quality execution of medical and other service documentation provided for by the current legal documents;
5. providing, in accordance with the established procedure, statistical and other information on their activities;
6. observance of executive discipline and performance of official duties by employees subordinate to it (if any);
7. prompt action, including timely informing management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of a medical organization, its employees, patients and visitors.
For violation of labor discipline, legislative and regulatory acts, a nurse can be brought in accordance with applicable law, depending on the severity of the misconduct, to disciplinary, material, administrative and criminal liability.
APPROVE:
[Job title]
_______________________________
_______________________________
[Name of company]
_______________________________
_______________________/[FULL NAME.]/
"______" _______________ 20___
JOB DESCRIPTION
nurse
1. General Provisions
1.1. This job description defines and regulates the powers, functional and job duties, rights and responsibilities of a nurse [Name of organization in the genitive case] (hereinafter referred to as the Medical Organization).
1.2. A nurse is appointed and dismissed in accordance with the procedure established by the current labor legislation by order of the head of the Medical Organization.
1.3. The nurse belongs to the category of specialists and is subordinate to [name of the position of subordinates in the dative case].
1.4. The nurse reports directly to [name of the position of the immediate supervisor in the dative case] of the Medical Organization.
1.5. A person who has a secondary vocational education in the specialty "General Medicine", "Obstetrics", "Nursing" and a certificate of a specialist in the specialty "Nursing", "General Practice", "Nursing in Pediatrics" without presentation work experience requirements.
1.6. The nurse is responsible for:
- effective performance of the work entrusted to her;
- compliance with the requirements of performance, labor and technological discipline;
- the safety of the documents (information) that are in its custody (become known to it), containing (constituting) the trade secret of the Medical Organization.
1.7. The nurse should know:
- laws and other regulatory legal acts of the Russian Federation in the field of healthcare;
- theoretical foundations of nursing;
- the basics of the treatment and diagnostic process, disease prevention, promotion of a healthy lifestyle;
- rules for the operation of medical instruments and equipment;
- statistical indicators characterizing the state of health of the population and the activities of medical organizations;
- rules for the collection, storage and disposal of waste from medical organizations;
- fundamentals of functioning of budget-insurance medicine and voluntary medical insurance;
- fundamentals of valeology and sanology;
- basics of dietology;
- the basics of clinical examination, the social significance of diseases;
- basics of disaster medicine;
- rules for maintaining accounting and reporting documentation of a structural unit, the main types of medical documentation;
- medical ethics;
- psychology of professional communication;
- fundamentals of labor legislation;
- internal labor regulations;
- rules on labor protection and fire safety.
1.8. The nurse in her work is guided by:
- local acts and organizational and administrative documents of the Medical Organization;
- internal labor regulations;
- rules of labor protection and safety, ensuring industrial sanitation and fire protection;
- instructions, orders, decisions and instructions of the immediate supervisor;
- this job description.
1.9. During the period of temporary absence of a nurse, her duties are assigned to [name of the position of deputy].
2. Job responsibilities
The nurse performs the following labor functions:
2.1. Provides pre-hospital medical care, collects biological materials for laboratory research.
2.2. Provides care to patients in a medical organization and at home.
2.3. Performs sterilization of medical instruments, dressings and patient care items.
2.4. Assists in the doctor's treatment and diagnostic manipulations and minor operations in outpatient and inpatient settings.
2.5. Conducts preparation of patients for various kinds of research, procedures, operations, for outpatient doctor's appointments.
2.6. Ensures fulfillment of medical orders.
2.7. Carries out accounting, storage, use of medicines and ethyl alcohol.
2.8. Maintains personal records, information (computer) database of the health status of the population served.
2.9. Supervises the activities of junior medical staff.
2.10. Maintains medical records.
2.11. Carries out sanitary-educational work among patients and their relatives on health promotion and disease prevention, promotion of a healthy lifestyle.
2.12. Collects and disposes of medical waste.
2.13. Carries out measures to comply with the sanitary and hygienic regime, the rules of asepsis and antisepsis, the conditions for sterilizing instruments and materials, the prevention of post-injection complications, hepatitis, HIV infection.
In case of official necessity, a nurse may be involved in the performance of her official duties overtime, in the manner prescribed by the provisions of the federal labor law.
3. Rights
The nurse has the right to:
3.1. Give subordinate employees and services instructions, tasks on a range of issues included in her functional duties.
3.2. Control the execution of production tasks, the timely execution of individual orders and tasks by subordinate services.
3.3. Request and receive the necessary materials and documents related to the activities of a nurse, subordinate services and units.
3.4. Interact with other enterprises, organizations and institutions on production and other issues related to the competence of the nurse.
3.5. Sign and endorse documents within their competence.
3.6. Submit for consideration by the head of the Medical Organization submissions on the appointment, transfer and dismissal of employees of subordinate units; proposals for their promotion or for the imposition of penalties on them.
3.7. Enjoy other rights established by the Labor Code of the Russian Federation and other legislative acts of the Russian Federation.
4. Responsibility and performance evaluation
4.1. The nurse bears administrative, disciplinary and financial (and in some cases, provided for by the legislation of the Russian Federation - and criminal) responsibility for:
4.1.1. Non-fulfillment or improper fulfillment of official instructions of the immediate supervisor.
4.1.2. Failure to perform or improper performance of their labor functions and assigned tasks.
4.1.3. Unlawful use of the granted official powers, as well as their use for personal purposes.
4.1.4. Inaccurate information about the status of the work assigned to her.
4.1.5. Failure to take measures to suppress the identified violations of safety regulations, fire and other rules that pose a threat to the activities of the enterprise and its employees.
4.1.6. Failure to enforce labor discipline.
4.2. Evaluation of the work of a nurse is carried out:
4.2.1. The immediate supervisor - regularly, in the course of the daily implementation by the employee of his labor functions.
4.2.2. Attestation Commission of the enterprise - periodically, but at least once every two years based on the documented results of the work for the evaluation period.
4.3. The main criterion for evaluating the work of a nurse is the quality, completeness and timeliness of her performance of the tasks provided for by this instruction.
5. Working conditions
5.1. The mode of work of a nurse is determined in accordance with the internal labor regulations established in the Medical Organization.
6. Right to sign
6.1. To ensure her activities, a nurse is granted the right to sign organizational and administrative documents on issues referred to her competence by this job description.
Familiarized with the instruction ___________ / ____________ / "____" _______ 20__
I. General provisions
1. The nurse belongs to the category of specialists.
2. A person who has a secondary medical education in the specialty "Nursing" and a medical education in the specialty "Nursing" and (having; not having) (I, II, highest) qualification category (s) is appointed to the position of a nurse .
3. Appointment to the position of a nurse and dismissal from it is carried out by order of the head of the institution.
4. The nurse should know:
4.1. Laws of the Russian Federation and other regulatory legal acts on health issues.
4.2. Fundamentals of the treatment and diagnostic process, disease prevention, promotion of a healthy lifestyle.
4.3. The organizational structure of the healthcare facility.
4.4. Safety rules for working with medical instruments and equipment.
4.5. Labor legislation.
4.6. Internal labor regulations.
4.7. Rules and norms of labor protection, safety measures, industrial sanitation and fire protection.
5. The nurse reports directly (to the doctor with whom she works, to the head nurse of the department)
II. Job Responsibilities
Nurse:
1. Provides infectious safety (complies with the rules of the sanitary-hygienic and anti-epidemic regime, asepsis, properly stores, processes, sterilizes and uses medical products).
2. Carries out all stages of the nursing process when caring for patients (initial assessment of the patient's condition, interpretation of the data obtained, planning care together with the patient, final assessment of what has been achieved).
3. Timely and efficiently performs preventive and treatment-diagnostic procedures prescribed by a doctor. Assists in the doctor's treatment and diagnostic manipulations and minor operations in outpatient and inpatient settings.
4. Provides emergency first aid in case of acute illnesses, accidents and various types of disasters, followed by a doctor's call to the patient or referral to the nearest medical institution.
5. Introduces drugs, anti-shock agents (in case of anaphylactic shock) to patients for health reasons (if a doctor cannot arrive in time to the patient) in accordance with the established procedure for this condition.
6. Informs the doctor or head, and in their absence, the doctor on duty about all detected serious complications and diseases of patients, complications resulting from medical manipulations or cases of violation of the institution's internal regulations.
7. Ensures the correct storage, accounting and write-off of medicines, compliance with the rules for taking medicines by patients.
8. Collaborates with colleagues and other service providers on behalf of the patient.
9. Maintains approved medical records and reports.
10. Systematically improves his professional qualifications.
11. Carries out sanitary and educational work to promote health and prevent diseases, promote a healthy lifestyle.
III. Rights
The nurse has the right to:
1. To apply conservative methods of treating patients as prescribed by a doctor, to carry out certain medical procedures.
2. Receive the information necessary for the accurate performance of their professional duties.
3. Make suggestions to improve the work of a nurse and the organization of nursing in the institution.
4. Require the head nurse of the department to provide the post (workplace) with equipment, equipment, tools, care items, etc., necessary for the high-quality performance of their functional duties.
5. Improve their qualifications in the prescribed manner, undergo certification (re-certification) in order to assign qualification categories.
6. Participate in the work of professional associations of nurses and other public organizations not prohibited by the legislation of the Russian Federation.
IV. A responsibility
The nurse is responsible for:
1. For improper performance or non-performance of their official duties provided for by this job description - to the extent determined by the current labor legislation of the Russian Federation.
2. For offenses committed in the course of carrying out their activities - within the limits determined by the current administrative, criminal and civil legislation of the Russian Federation.
3. For causing material damage - within the limits determined by the current labor and civil legislation of the Russian Federation.
